What antibiotic is recommended for a 12-year-old with a bacterial Upper Respiratory Infection (URI)?

Antibiotic Treatment for a 12-Year-Old with Bacterial URI

For a 12-year-old with bacterial upper respiratory tract infection (URI), high-dose oral amoxicillin (90 mg/kg/day divided in 2 doses, maximum 4 g/day) is the first-line treatment. 1

First-Line Treatment Options

• Amoxicillin is the preferred treatment for bacterial URIs in children, specifically indicated for upper respiratory tract infections of the ear, nose, and throat due to susceptible strains of Streptococcus species, Streptococcus pneumoniae, Staphylococcus species, or Haemophilus influenzae 2
• The recommended dosage is 90 mg/kg/day divided in 2 doses (or 45 mg/kg/day in 3 doses) for optimal coverage against potentially resistant organisms 3, 1
• Treatment should continue for a minimum of 48-72 hours beyond symptom resolution 2

Important Considerations

• Most URIs are viral in origin and do not require antibiotic therapy 4, 5
• Antibiotics should only be prescribed when there is strong clinical evidence of bacterial infection to avoid contributing to antibiotic resistance 4
• To minimize gastrointestinal intolerance, amoxicillin should be taken at the start of a meal 2
• Clinical improvement should be expected within 48-72 hours of initiating appropriate therapy 1

Alternative Treatment Options

If the patient has a penicillin allergy or treatment failure with amoxicillin:

• Second or third-generation cephalosporins (cefpodoxime, cefuroxime, cefprozil) are appropriate alternatives 3
• For patients with severe penicillin allergy, oral clindamycin (30-40 mg/kg/day in 3 doses) can be considered 3
• In areas with high pneumococcal resistance or treatment failure, ceftriaxone (50-100 mg/kg/day) may be used 6

Special Situations

• If atypical pathogens are suspected, consider adding a macrolide antibiotic 1
• For MRSA infections, clindamycin (if susceptible) is the preferred oral option at 30-40 mg/kg/day in 3-4 doses 3
• For severe infections requiring hospitalization, parenteral therapy with ampicillin (150-200 mg/kg/day) or ceftriaxone (50-100 mg/kg/day) should be considered 3, 1

Monitoring and Follow-up

• Assess for clinical improvement within 48-72 hours of starting therapy 1
• If no improvement occurs, consider alternative diagnoses, resistant organisms, or changing the antibiotic regimen 1
• Complete the full course of antibiotics even if symptoms improve quickly to prevent recurrence and resistance development 2